Background/Purpose: Immune checkpoint inhibitors (ICI) have improved cancer outcomes but can cause severe toxicity and flares in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify what information physicians perceived would be most useful for cancer patients with pre-existing autoimmune disease to make decisions about whether to receive ICI.

Methods: We interviewed oncologists and clinicians from other internal medicine specialties practicing at a cancer institution with experience in the treatment of immune-related adverse events (irAE). Using a semi-structure guide, we explored the type of information patients with autoimmune disease need to know in order to make an informed decision about whether to receive an ICI. We performed qualitative analysis using thematic analysis methods to organize, sort, and interpret data from the participants.

Results: Twenty clinicians were interviewed. Physicians were melanoma oncologists (30%), thoracic-head & neck medical oncologists (25%), rheumatologists (20%), gastroenterologists (10%), and dermatologists (15%). Most physicians felt confident (extremely 20%, quite a bit 45%) in managing patients with cancer and pre-existing autoimmune diseases who receive ICI . Most physicians (75%) agreed on the need for developing a visual tool to be used during the clinical encounter, specific for patients with pre-existing autoimmune diseases. All participants highlighted the importance of having multiple delivery formats including web-based and written materials that could be integrated into the electronic medical record system. The key points suggested were information on probability of developing irAEs, risks of flares of underlying autoimmune condition with ICI, and benefits of ICI. Specifically for rheumatologists, learning points were centered on how ICI would affect the outcome of the autoimmune disease and included: 1) impact on disease activity, 2) changes in medications for autoimmune disease, 3) probability of flare-ups of autoimmune condition, 4) available treatment options for flare-ups, 5) other possible irAEs, 6) description of patient symptoms that would require immediate attention, 7) follow-up and monitoring of the autoimmune condition, 8) good sources of information beside asking doctors, and 9) potential influence of steroids on the tumor response to ICI.

Conclusion: We identified key learning points perceived by physicians to be important for cancer patients with autoimmune disease considering treatment with ICI. These learning points can be incorporated to patient-doctor discussions and to educational tools to improve shared decision making in patients with cancer and pre-existing autoimmune disease who are candidates for ICI therapy for their cancer.

Disclosure Statement: This study was funded by the Rheumatology Research Foundation and the National Cancer Institute (CA237619).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/priority-educational-topics-to-deliver-information-about-immune-checkpoint-inhibitors-for-patients-with-cancer-and-a-pre-existing-autoimmune-disease/